The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Saturday, October 24, 2009

More medical indifference in a British government hospital

Meningitis girl's three-hour wait for drug that could have saved her

A TEENAGE girl dying from meningitis begged and pleaded with nurses to give her antibiotics, an inquest heard. But Melissa Watmough, 17, had to wait nearly three hours for the drugs after arriving by emergency ambulance to the Manchester Royal Infirmary. There was then a delay of almost two hours before she was seen by a doctor and then another hour before she was administered the antibiotics she hoped would save her life.

Melissa's mum Joanne told the inquest: "I might as well have let her stay at home and die quietly. In our view the hospital did not treat her quickly enough. "We believe that if she would have received the appropriate antibiotic treatment earlier in the process she would still be here today. Meningitis is a deadly disease. All the guidance suggests that time is of the essence. "Melissa was becoming very scared and concerned about her health and begged the nurse to give her antibiotics."

Her family are now considering legal action over her treatment.

Carolyn Singleton, Manchester assistant deputy coroner, ruled Melissa died from natural causes. She urged the hospital to discuss the case with her family and said: "Clearly they believe that had antibiotics been administered when she arrived at hospital, she may have had a fighting chance."

Sue Davie, Chief Executive of the Meningitis Trust, said: "Bacterial meningitis and meningococcal septicaemia are medical emergencies and need immediate treatment with antibiotics, together with admission to hospital. Early treatment with antibiotics can have a significant impact on the outcome of bacterial meningitis."

The inquest heard that Melissa, a hairdressing student at Mancat College, was rushed from her home in Abbey Hey, Gorton, to hospital by ambulance after showing all the classic symptoms of meningitis. She died three days later on the day before Christmas Eve last year. Her family are now considering legal action over her treatment.

An inquest heard Melissa woke up feeling unwell on December 20 and later complained of headache, sickness and a high temperature. A rash also developed on her legs. Her mother Joanne, 40, carried out the 'glass test' advised by the Meningitis Trust and the rash did not disappear. She telephoned an out-of-hours medical advice service and suspected meningitis was diagnosed.

The inquest heard that the advice pointed to three 'red flag' signs, meaning Melissa was displaying three recognisable symptoms of meningitis. An ambulance was sent to pick her up immediately and Melissa was taken as an emergency patient to the MRI. The inquest heard that she arrived at the hospital at 7.16pm but nurses downgraded her condition after an initial examination and it was 9pm before she was seen by a doctor. The doctor said he wished to take a blood sample before antibiotics were administered and it was only when her condition worsened that she was given antibiotics at around 10pm. She was transferred to Hope Hospital in Salford and placed on a life support machine but died on December 23.

John Bachelor, a consultant in emergency medicine at the MRI, told the hearing at Manchester Coroner's Court: "She did present with non-specific symptoms and went down hill very rapidly and developed severe complications of the disease. "It can be very difficult to distinguish between other viral infections." He said it was 'not common practice' to 'blindly' give antibiotics until patients were thoroughly examined and blood tests taken. Dr Bachelor said: "It would not have made any difference to the outcome if she would have been given antibiotics on arrival."

A spokesman for Central Manchester University Hospital's NHS Foundation Trust said: "The Trust would like to extend its sincere condolences to Melissa Watmough's family. We are aware that the family still have concerns after the inquest and we would encourage them to contact the Trust to discuss this further."

More than 80% of likely voters rate most of President Barack Obama's healthcare reform proposals as important to them and their families, but majorities also share concerns about reform proposals that have been raised by Republicans. Those are findings of a Zogby Interactive poll of 3,694 likely voters conducted from October 16-19, 2009. The margin of error is +/-1.9%.

The poll asked voters to rate the importance of seven of Obama's primary goals for healthcare reform. Only one of the seven goals, making sure all U.S. citizens have coverage, had fewer than 80% rate it as important.

The second part of the survey provided six concerns about Democratic healthcare proposals that have been raised by Republicans. Voters were asked if they were concerned about each, and more than half, between 58% and 67%, were somewhat or very concerned.

There were very sharp partisan differences on all of the questions asked for both the importance of goals and concerns about what the proposals might do. More than 90% of Republicans were concerned about each of possible negative outcomes, and 90% of Democrats rate each of Obama's goals as important.

Majorities of Republicans say all the goals except universal coverage are important, and are within 10 points of the results of the whole sample. However, Republicans are much less likely than Democrats or Independents to rate any of as the goals as "very important." For example, on ending denial of coverage for pre-existing conditions, 41% of Republicans rate it "very important," compared to 84% of Democrats and 65% of Independents who say the same.

On universal coverage, 14% of Republicans say coverage for all citizens is very important, and 28% feel it is not at all important.

Among Democrats, the percentage who share concerns about the bill's possible effects range from a high of 41% on whether their taxes may increase to a low of 25% on whether they might be forced into a government plan.

Results for Independent voters for all of the questions asked are very close to those of the overall sample.

On the New York Times Prescriptions health blog today, Milt Freudenheim has written about some buried provisions in the 1,500 page Senate health care bill that will be particularly costly for senior citizens:

The Senate Finance Committee has quietly recommended that millions elderly Americans who buy Medigap plans be charged new co-pays for doctor’s visits starting in 2015. ...

The new co-pays are intended to push elderly patients to think twice before consulting their doctors. Some studies have found that Medigap policyholders use at least 25 percent more health care services than the generally lower-income Medicare enrollees who do not have Medigap policies.

The Left howled and moaned when critics of the president's plan warned that it would lead to rationed coverage for senior citizens--all lies and falsehoods they said. But what do you call a co-pay specifically designed to make elderly patients think twice before seeing a doctor?

And where is the AARP to complain about this? As Sweetness & Light points out today, "Lest we forget, the Reagan catastrophic healthcare reform legislation was repealed once seniors and the AARP discovered that it might require the richest participants to pay up to $560 for their yearly deductible. How times have changed."

When Norwegian politician Vidkun Quisling was tried and shot for abetting the Nazi occupation of his country during WWII, his name entered the vernacular as a synonym for "collaborator." It is difficult to think of a more appropriate adjective to describe the health care "stakeholders" who have been genuflecting at the altar of "reform" since the Obama administration marched into Washington last January. While actual patients have protested at town hall meetings and organized demonstrations against Obamacare, the American Medical Association, the American Hospital Association, the Pharmaceutical Research and Manufacturers of America, America's Health Insurance Plans and a variety of other industry groups have been hard at work currying favor with their new masters.

The most transparently self-serving of these stakeholders has been the AMA. The waning but still influential physician association was among the first to join with the new administration in its effort to take over U.S. health care. The President of the AMA, J. James Rohack, began parroting the empty platitudes of reform shortly after the election and jostled with his fellow quislings for a conspicuous place at the May press conference at which Obama announced his "historic" cost-cutting deal with industry players. As Rohack put it at the popular medical blog, Kevin, MD: "In an unprecedented endeavor aimed at achieving health-care reform this year, the American Medical Association stood with President Obama and other key health-care stakeholders Monday to announce efforts to 'bend the spending curve' on health care."

But Dr. Rohack wasn't there to bend the spending curve or to promote genuine health care reform. He was there to protect his paycheck. Specifically, he wants to stop an imminent and deep reduction in the amount of money the government pays doctors. Medicare's physician payment scheme, the Sustainable Growth Rate (SGR) formula, mandates a 21% cut -- and it is due to be implemented next January. It is this "curve" that the American Medical Association is truly seeking to "bend." As it is phrased at the AMA website: "Permanent reform of the archaic Medicare physician payment system is among the core principles the AMA is urging Congress to include as part of comprehensive health system reform this year." Dr. Rohack is obviously hoping that collaboration on the Democrat reform charade will earn the AMA a presidential pardon from SGR-mandated cuts.

The American Medical Association was not always so ready to collude with the enemy. Motivated by well-founded fears that government-run health care would inevitably lead to bureaucratic interference in the practice of medicine, the AMA actively opposed Harry Truman's post-WWII attempt to impose nationalized health care on the country. Likewise, the organization vigorously opposed the enactment of Medicare during the early 1960s. It even launched what is often cited as the first viral marketing campaign, "Operation Coffee Cup," featuring an LP of Ronald Reagan describing the dangers of socialized medicine. During the early 1990s, after some early flirtations with the Clinton health care "reforms," the AMA eventually joined the coalition of health industry organizations that provided Hillarycare with its much-needed end-of-life counseling.

The once-feared organization has become far more pliant in recent years, however. Since the Sustainable Growth Rate formula was imposed in the 1990s, the AMA has repeatedly been forced to go hat-in-hand to its Beltway masters for stays of execution. Each time, Congress has issued a reluctant reprieve from payment cuts -- but not without a price. In exchange for its 2008 reprieve, the AMA was forced to cooperate with congressional Democrats in their disgraceful move to gut Medicare Advantage (MA), a program that has greatly benefited poor and minority seniors. In that tawdry episode, the Dems attached an SGR waiver to a bill that cut funding for Medicare Advantage, whereupon the AMA cravenly began parroting DNC talking points about insurance company profits. This collusion helped the Democrats push through the first of several cuts in MA funding.

This year, the price of the AMA's reprieve is support of whatever health care legislation emerges from Congress. And, so long as the final bill does away with SGR, the organization is obviously prepared to be a willing accomplice in whatever fraud the Democrats perpetrate. Thus Dr. Rohack rhapsodized about HR 3200, the widely-panned House version of Obamacare: "This legislation includes a broad range of provisions that are key to effective, comprehensive health system reform." HR 3200 includes nothing of the sort, but it does contain a provision that would repeal SGR. Meanwhile, the absence of such a provision in the Senate Finance Committee bill produced a noticeably tepid response from the good doctor, despite a $250 billion sop to Cerberus that purports to solve the SGR problem.

There are, of course, legitimate reasons to oppose the SGR. This payment formula, like the PPS methodology to which the federal government subjects most hospitals, is nothing more or less than a Soviet-style price control system. And, as with all price control schemes, the SGR has failed to control costs and created distortions in the market. One of its most conspicuous effects has been a shortage of primary care physicians willing to treat Medicare patients. Unfortunately, the current AMA leadership has decided not to seek any real change in this perverse and counterproductive system. Instead of using the association's leverage to force genuine free market reforms, Dr. Rohack has settled on a strategy designed to produce a special dispensation for his members, regardless of the damage it does to our health care system.

The tragic irony of this cynical strategy is that it will not work. As Vidkun Quisling discovered in October of 1945, the advantages of collaboration are always short-lived. A temporary reprieve from Medicare payment cuts is all Dr. Rohack will have gained by delivering his patients and colleagues into the hands of Washington's health care bureaucrats. Because socialized health care systems are explicitly designed to circumvent the market mechanisms that actually control costs, they must always revert to the only remaining alternatives: rationing services to patients and cutting payments to providers. All government-run systems do both, and Obamacare will be no different. Once the President has finished using them for political cover, the AMA and the rest of the "stakeholders" will be abandoned to the depredations of bureaucrats and the revenge of an angry public. This is the inevitable fate of all quislings.

New Survey Shows Providers Feel Left Out of Debate on Health Reform: Most Doctors, Nurses Believe Medical Expertise Excluded from Debate

Two-thirds (66%) of physicians surveyed and a majority (53%) of nurses surveyed believe that their expertise has barely been considered in healthcare reform. Beyond this, a substantial plurality of physicians (43%) and a majority of nurses (54%) indicate that they have not received enough information to understand the policy changes being proposed as part of healthcare reform, according to a survey released this week, as the Senate prepares to begin floor debate on health reform.

"Physicians and nurses are feeling bypassed as it relates to the debate around healthcare reform," said Robert Chandler, principal, Chandler Chicco Companies. "Making sure this important group of stakeholders feel their voices are being heard should be the top priority for the President, the Congress and the media. After all, these are the people on the frontlines of healthcare delivery."

This survey also revealed that roughly 9 in 10 (88% of physicians, 90% of nurses) respondents describe news coverage of healthcare debate as being too focused on politics instead of policy.

"Patients rely on doctors and nurses who treat them for information about health and health care," said Chandler. "Given these findings, it is not surprising that many Americans are unsure about whether the health reform debate in Washington will actually result in better health care."

Additional survey findings:

* A plurality of physicians (43%) and majority of nurses (54%) surveyed say they don't understand the policy changes being proposed as a part of healthcare reform.

* 7 in 10 (70%) physicians surveyed believe that tort reform is not likely to result in less recourse for patients.

* Approximately 6 in 10 physicians surveyed believe that tort reform is extremely or very likely to lead to fewer unnecessary tests (63%) and lower insurance costs (59%).

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Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here